Good Faith Estimate

You have a right to receive a "Good Faith Estimate" explaining how much your medical care will cost.

Under the law, health care providers must give patients who don’t have insurance or who are not using insurance an estimate of the bill for non-emergency medical items and services.

• You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency items or services. This includes costs like office visits, medical tests, prescription drugs, equipment and hospital fees.
• Ask your health care provider for a Good Faith Estimate in writing at least one business day before your scheduled care. You can also ask your health care provider, and any other provider you choose, for a Good Faith Estimate before you schedule an item or service.
• If you receive a bill that is at least $400 more than your Good Faith Estimate, you can dispute the bill.
• Please save a copy or picture of your Good Faith Estimate.

To learn more about your right to a Good Faith Estimate, visit www.cms.gov/nosurprises or call 207-872-4680, option 5
or toll free at 1-877-255-4680, option 5.